Patients with clinical depression “stopped seeking treatment” during the COVID waves

Reports and Proceedings

EUROPEAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY

 

IMAGE: PATIENTS HOSPITALISED FOR DEPRESSION, GERMANY 2020 view more 

CREDIT: MAREIKE AICHHOLTZER

In the first study of its kind, German researchers have shown that the COVID pandemic saw a huge drop in the number of patients being admitted to hospital for clinical depression. Independently of these national statistics, the researchers found that the number of outpatients they dealt with increased over the same period in their department. As inpatient treatment offers more intensive levels of care, this implies that many patients did not receive care appropriate to their condition. It is not yet known if this shift in treatment is also seen in other countries.

The researchers, from the University Hospital in Frankfurt, looked at German national databases. They found that during the first COVID wave new hospitalisations for first time clinical depression dropped by 57.5%, from 13457 in January 2020 down to 5723 in April 2020. In the same period, the number of patients being hospitalised for recurrent depression dropped by 56.3%, from 22188 down to 9698.

Lead researcher, Dr Mareike Aichholzer said “We also saw a decrease in inpatient treatment of recurrent depression in our own hospital in Frankfurt. In addition to the stricter admission rules, this rather seemed to be due to a drop in demand from the patients themselves”.  

In contrast, the number of new outpatients being treated for clinical depression at the University Hospital in Frankfurt remained stable and the number of patients with recurrent depression showed a significant increase between 2019 and 2021.  However, Dr Aichholzer notes “This is data from a single centre, so we need to wait to see what other centres say”.

She continued, “The results indicate that patients who have repeatedly suffered from depression during their lives were less likely to be admitted to hospital during the pandemic. However, these patients are often so severely affected by depression that outpatient treatment alone is not sufficient to bring about a satisfactory improvement in symptoms. The result is that patients lose their quality of life in the long term. The actual reason for this observation is unclear. Although our study was not designed to identify the reasons for those changes, we however suspect that clinically depressed patients in particular withdraw more often from society/their friends/their family and that this behaviour was more common during the times of the lock-down and the strict hygiene guidelines. Moreover, we suspect, that clinically depressed patients avoided the hospital, because they were afraid of being infected with COVID-19 on the ward.

The data from our hospital in Frankfurt indicates that patients with clinical depression seem to have withdrawn themselves, rather than seeking adequate mental health help. To be prepared for the winter with potentially increasing COVID numbers, we have to provide easily accessible help and raise awareness for this topic”.

Clinical depression, also known as Major Depressive Disorder (MDD) is a serious mental illness, affecting more than 6% of Europeans at any one time. The majority of sufferers can be treated with pharmaceuticals and/or counselling, although a minority of patients don’t respond to treatment.

Commenting, Professor Brenda Penninx, Professor of psychiatric epidemiology at the Department of Psychiatry, University Medical Centre, Amsterdam, said:

“The figures found by the Frankfurt team confirm a familiar pattern. We have recently found that quite a few countries are beginning to report a decreased pattern of mental health care use during the first pandemic years. It is extremely important that in the next few years we follow whether postponed treatments may result in increased mental health problems. This also illustrates that mental health care deserves adequate clinical attention during future pandemics”. 

This is an independent comment, Professor Penninx was not involved in this research.

Notes

Poster P.0127  Impact of covid-19 on German treatment numbers of patients with depression – a gap in care for the mentally ill? (researchers M. Aichholzer, C. Schiweck, C.Uckermark, T.Hamzehloiya, C.Reif-Leonhard, A. Reif, and S. Edwin Thanarajah) will be presented at the 35th European College of Neuropsychopharmacology annual conference, which takes place in Vienna and online from 15-18 October, see https://www.ecnp.eu/Congress2022/ECNPcongress. Up to 5000 delegates are expected to attend. The ECNP is Europe’s main organisation working in applied neuroscience.

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METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

Eating well and avoiding the news gave the best mental health outcomes during COVID

Reports and Proceedings

EUROPEAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY

 

IMAGE: HOW MUCH ANXIETY AND DEPRESSION DO BEHAVIORS PREVENT? view more 

CREDIT: JOAQUIM RADUA

A healthy diet and avoiding the news helped prevent anxiety and depression during COVID, even better than interacting with friends, following a routine, or pursuing hobbies. A preliminary finding about diet was published earlier this year and the final findings are presented at the ECNP conference in Vienna.

Dr Joaquim Radua led a team of Barcelona-based researchers who compared how various health activities could reduce anxiety and depression during the COVID pandemic.

He said: “We saw, of course, that the COVID-19 pandemic increased anxiety and depressive symptoms in the population. Health bodies recommended several behaviours to cope with them, but no studies had followed the effect of these behaviours on anxiety and depressive symptoms over time; there was no real evidence on how much they work. So we decided to test what worked best”.

The researchers followed 942 Spanish adults for one year. Every 2 weeks, the volunteers rated the frequency of 10 selected coping behaviours and noted their levels of anxiety and depression. At the end of the period, the researchers analysed which behaviours at a given time were associated with fewer anxiety/depressive symptoms in the subsequent four weeks.

They found that some of the behaviours monitored were associated with coping better during the COVID pandemic. These included following a healthy/balanced diet, not reading news updates about COVID too often, physical exercise, staying outdoors, and drinking water. On the other hand, some behaviours that had been generally thought to be beneficial, such as talking with relatives or friends, or following a hobby, had a smaller influence on the mental health outcomes investigated in this study.

Dr Radua said, “This was a little surprising. Like many people, we had assumed that personal contact would play a bigger part in avoiding anxiety and depression during stressful times. The relationships between behaviours and symptoms were difficult to tease out because we were looking at what happens over time rather than just at a single moment of analysis. For example, in a previous pilot study, we found that those who followed a hobby showed less anxiety and depression. However, we did not know whether people first do hobbies and then feel relaxed/happy. Or conversely, people first feel relaxed/happy, and then these feelings make them follow hobbies. We wondered if, rather than the hobbies preventing depression, we were seeing that those who get depressed give up their hobbies. We also needed to correct the effect of past symptoms on future symptoms”.

He continued, “This shows what makes this study unique: it is based on evidence gathered over a long follow-up. We think it’s important that people continue to follow what works for them and that if you enjoy seeing friends or following a hobby, you continue to do so. However, on the basis of these results, we recommend that everybody follows a healthy/balanced diet, avoids watching stressful news too often, spends more time outdoors, does relaxing activities, and does physical exercise. Our work was centred on COVID, but we now need to see if these factors apply to other stressful circumstances. These simple behaviours may prevent anxiety and depression, and prevention is better than cure”.

 

Commenting, Professor Catherine Harmer, Director of the Psychopharmacology and Emotional Research Lab (PERL) at the University Department of Psychiatry in Oxford said:

“This is an interesting study focused on the kinds of coping behaviours that were associated with reduced depression and anxiety over a year of the covid-19 pandemic.  A strength of the study is that it collected responses repeatedly in the same individuals, every 2 weeks, for a year.  The authors then looked at which behaviours were most associated with depression and anxiety over the next 4 weeks (that is which predicted change in symptoms).  The results suggested that healthy eating, avoiding stressful news, drinking water, staying outdoors and taking part in relaxing activities showed a protective effect on mental health during this stressful period.  Interestingly, social contact and hobbies were less important than previously thought.

This study provides some important insights as to which  behaviours may protect our mental health during times of significant stress.  Future work is needed to test whether these associations are causal - is it these behaviours which cause improvements in mood or could it be the other way around - as we feel better we start to engage more positively with our environment?”

Professor Harmer was not involved in this work; this is an independent comment.

This work is presented at the 35th European College of Neuropsychopharmacology annual conference, which takes place in Vienna and online from 15-18 October. Up to 5000 delegates are expected to attend. The ECNP is Europe’s main organisation working in applied neuroscience. see https://www.ecnp.eu/Congress2022/ECNPcongress.

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METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

The more specifics people have on potential dangers, the less fearful they become

Providing detailed information on probabilities can reduce fear of negative outcomes, according to new UC San Diego research

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - SAN DIEGO

The COVID-19 pandemic highlighted the personal and social importance as well as the challenges of estimating risks. New research from the University of California San Diego sheds light on how people perceive risks, finding that detailed knowledge of probabilities can make risks seem less risky.

For example, if people are informed that 27% of the population carries at least one copy of a  gene that can cause Alzheimer’s Disease, they may worry they have that gene. However, if you specify that this occurs because 25% have one copy of the gene and 2% have two copies of the gene, the subjective perception of risk becomes less urgent. Yet, it is still true that 27% of people carry a gene that could lead to Alzheimer. 

“There’s something about learning those individual probabilities that shifts the way you think about the risk and causes you to actually reduce your estimate it will occur,” said Uma R. Karmarkar, study co-author and assistant professor of marketing and innovation at UC San Diego’s Rady School of Management and School of Global Policy and Strategy.

The robust results, published in the Journal of Experimental Psychology: General, are based on findings that were replicated in more than a dozen different experiments with more than 1,500 participants living across the U.S. 

In one experiment, 390 subjects who participated in the study via Amazon’s Mechanical Turk platform were assigned into three groups. All groups were provided with the information that “every single person has a 58% chance of getting a flea bite that causes a newly discovered bacterial infection.” Then, two groups were given more specific information. One group saw that the bites could come from various types of fleas and this caused them to think a flea bite was more likely. A different group saw the various types of fleas, and the probability of a bite from each type–receiving the explicit probability information led them to perceive the initial warning as less likely to happen. 

“Giving all those independent reasons with their probabilities may seem like it would enhance a recognition of how important an event is, but can actually diminish the overall risk,” Karmarkar said. “When this happens, the ‘unlikelihood effect’ comes into play. One thing that this means is that providing specific information on probabilities can help alleviate fear of negative outcomes.”

While the study focused on health risks, the authors also tested the theory using potential positive outcomes, such as winning a lottery. Alongside the overall probability of hitting the jackpot, some subjects received supplementary information, such as “if I pull a colored ball from this urn, you’ll win 50 dollars.” This additional information made subjects perceive themselves as less likely to win. In positive scenarios, the “unlikelihood effect” still holds.

Karmakar notes that how institutions and policymakers provide information about health risks has become increasingly crucial. 

“When communicating about risks, it’s important to be mindful of the goals of providing such information and what behaviors it is intended to drive,” she said. “This research can help policymakers refine their messaging to make sure their communications are impactful.”  

The paper “The Unlikelihood Effect: When Knowing More Creates the Perception of Less” is co-authored by Daniella Kupor of the Questrom School of Business at Boston University. 

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JOURNAL

Journal of Experimental Psychology

DOI

10.1037/xge0001306 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

The Unlikelihood Effect: When Knowing More Creates the Perception of Less

ARTICLE PUBLICATION DATE

14-Oct-2022

New study investigates how beliefs and political affiliations shape the public’s understanding about racial inequalities

Peer-Reviewed Publication

SYRACUSE UNIVERSITY

A recently released study coauthored by a Syracuse University researcher reveals how beliefs and political affiliations shape the public’s understanding about racial inequalities.

The paper, “Historical information and beliefs about racial inequality,” was released earlier this year and published in the academic journal Politics, Groups, and Identities.

The researchers—Steven White, Assistant Professor, Syracuse University, Maxwell School of Citizenship and Public Affairs, and Albert Fang, an independent scholar based in New York City—evaluated if learning about historical events, and especially the roots of racist politics and practices in America, impact people’s beliefs about systematic racial inequality.

They analyzed data from two key studies that surveyed adults who were randomly assigned to learn about the effects of systematic housing, education, and job discrimination that has negatively impacted Black communities throughout the United States.  

According to Fang and White, they “find compelling evidence that such arguments can increase beliefs in the existence of Black-white racial inequality and increase beliefs in structural causes of racial inequality, particularly among white Republicans and Independents.” They also find evidence that such information can reduce racial resentment among these groups.

The researchers say this demonstrates that exposure to historical information can induce more nuanced thinking about contemporary racial inequalities in the United States.

The researchers conclude that more study is needed for more questions arising from the research. First, they did not observe consistent effects, especially among white Republicans, of historical information on both beliefs about racial inequality's existence and beliefs in various structural causes of racial inequality. 

“We suspect this reflects differences between acknowledging a problem, acknowledging the causes of a problem, and agreeing on the solution. This suggests that even if more Americans acknowledge that racial inequality exists, agreeing on solutions to meaningfully redress it may be more difficult,” the researchers write in the paper.

Reporters looking to connect with the authors of the report, please contact Ellen James Mbuqe, executive director of media relations at Syracuse University, at 412-496-0551 or ejmbuqe@syr.edu.

 

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JOURNAL

Politics Groups and Identities

DOI

10.1080/21565503.2022.2104167 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Historical information and beliefs about racial inequality

PRICE GOUGING IS CAPITALI$M

First a disaster. Then a surge in prices

UTA researchers work to predict and counter reconstruction demand surge after disasters

Grant and Award Announcement

UNIVERSITY OF TEXAS AT ARLINGTON

 

IMAGE: MOHSEN SHAHANDASHTI view more 

CREDIT: UT ARLINGTON

a natural disaster comes the demand surge. The cost of materials and labor needed for reconstruction rises dramatically. This slows down the rebuilding process and may prevent many people, especially those in vulnerable communities, from rebuilding at all.

Mohsen Shahandashti, associate professor of civil engineering at The University of Texas at Arlington, recently received a three-year, $250,000 grant from the National Science Foundation to develop methods to measure, model and conduct community vulnerability assessments to determine what construction gaps exist so they can prepare for and mitigate demand surge in future disasters. Mahmut Yasar, a professor of economics in the College of Business, is co-principal investigator.

“I know disasters and the build environment, and Dr. Yasar is an expert in economics and human factors. It’s really exciting to be able to study this fundamental problem from both sides of the issue and come up with solutions that will help communities rebuild faster and at lower cost,” Shahandashti said.

The team will address fundamental limitations of existing demand surge models in multiple ways:

• creating non-hazard baselines for housing construction cost variations
• developing a measurement method for quantifying post-disaster construction cost escalations
• creating models to represent the housing reconstruction demand surge
• assessing housing reconstruction vulnerability of communities
• quantifying the impacts of disaster-related policies on housing reconstruction

The greatest costs of rebuilding after a disaster are construction-related materials and labor, Shahandashti said. Some materials are used immediately, while others aren’t needed until later. Costs for some materials may rise immediately, while others may increase in price later as they become less available.

“When we get our results, we can create models to test how demand and needs will actually happen,” he said. “We’ll look not only at whether or not costs change, but why. The results of these models will allow community leaders to evaluate policies to help mitigate demand surge and benefit the citizens of the affected communities.”

• Written by Jeremy Agor, College of Engineering

Breedbase software to help speed crop improvement

New open-source software can help plant breeders make crops more resistant to pests, pathogens, drought, floods and more. These crop improvements will be essential to help feed the world in the current era of population growth and climate change

BOYCE THOMPSON INSTITUTE

 BTI’s Lukas Mueller and Nicolas Morales in the Institute’s server room.
Credit: Image credit: Boyce Thompson Institute.

ITHACA, NY - To help plant breeders speed crop improvement around the world, Lukas Mueller of the Boyce Thompson Institute worked with an international team of 57 people to create Breedbase, a database software that was described in the July issue of G3.

“In the current era of population growth and climate change, plant breeding needs to be faster to ensure crops survive new pests and pathogens that are expanding their ranges, as well as unpredictable weather patterns,” said Mueller.

Plant breeding is the process by which people improve plant traits, such as increasing yield or making them resistant to disease. Breeders and farmers traditionally have done this by crossing plants that have desirable traits, like larger and tastier fruit. But traditional plant breeding is a long and slow process, taking generations to achieve results.

In today’s genomics era, plant breeding has undergone drastic changes. In an approach termed “Genomic Selection,” breeders determine the genomic properties of plant lines and correlate them with traits, which allows them to predict traits based on genomic information. Plant breeders make decisions based on these predictions much faster than they would with the traditional approach of growing and observing the plants. 

However, genomic approaches generate massive amounts of data that can be challenging to manage, especially for smaller breeding programs in developing countries. To be of use to breeders and researchers, the data need to be stored in specialized databases with precise organization, data management, quality control and analytics.

Up until now, plant breeders and researchers have typically collected data in non-standardized ways using spreadsheets, making it difficult to organize, share and analyze data with each other.

“Breedbase solves these problems by creating a common data language, and a free data tracking system that will change the way plant breeders communicate and archive all important breeding data,” says Nicolas Morales, a graduate student in Mueller’s group.

“Clear, organized data management and analysis is crucial to successful and efficient plant breeding. In order to grow plants that feed people in a nutritious and healthy way, plant breeding data management needs to be simplified, standardized and accessible to everyone who needs it,” says Mueller, who is also an adjunct professor at Cornell University’s School of Integrative Plant Science.

In addition to storing data, Breedbase includes algorithms that a breeder could run, such as predicting whether a plant variety has a particular trait, such as disease resistance or high yield.

“Breedbase makes complicated things easy. It’s like a giant tool box with all the tools you need in one central place,” says Morales, who is co-first author of the paper with former Mueller graduate student Alex Ogbonna.

A key component of Breedbase is the Breeding Application Programming Interface (BrAPI), which standardizes how data are collected. This standardization allows plant breeders to more easily exchange data among disparate databases and computer-based breeding tools. For example, if a person wants to collect data in the field and has no internet connection, they can collect data on a tablet using an app, and then download the data to a database when they return to their computer, using a BrAPI interface behind the scenes.

Importantly, everything is standardized, so that a farmer growing corn in Iowa and another farmer growing corn in Africa will be able to easily share their data with each other, speeding up discoveries to improve crop traits.

“Empowering plant breeders in developing countries allows even smaller breeding programs to leverage genomic information to make breeding selections and help feed the world,” says Mueller.

Breedbase is based on Cassavabase, which the Mueller Lab developed with NextGen Cassava, a project that brought cassava breeding to the next level at institutions in Africa and uses cutting-edge tools to efficiently deliver improved varieties of cassava.

In addition to cassava, at least 50 crop databases already use Breedbase, including yam, bananas, sweet potato, rice, tomatoes and carrots.

About Boyce Thompson Institute:

Opened in 1924, Boyce Thompson Institute is a premier life sciences research institution located in Ithaca, New York. BTI scientists conduct investigations into fundamental plant and life sciences research with the goals of increasing food security, improving environmental sustainability in agriculture, and making basic discoveries that will enhance human health. Throughout this work, BTI is committed to inspiring and educating students and to providing advanced training for the next generation of scientists. BTI is an independent nonprofit research institute that is also affiliated with Cornell University. For more information, please visit BTIscience.org.

Sexual and gender minorities assigned male at birth have higher odds of partner violence

Young bisexual, transgender and low-income individuals are most at risk of psychological and physical victimization, according to a Rutgers study

Peer-Reviewed Publication

RUTGERS UNIVERSITY

Intimate partner violence is chronic among young sexual and gender minorities assigned male at birth (YSGM-AMAB), with bisexual, transgender and lower-income people in this group having the highest likelihood of victimization, a Rutgers study has found.

“Our findings demonstrate just how common and chronic intimate partner violence is for young gender and sexual minorities,” said Marybec Griffin, an assistant professor in the Department of Health Behavior, Society and Policy at Rutgers School of Public Health and coauthor of the study, which was published online ahead of print in the Journal of Interpersonal Violence September issue.

“The common perception is that violence happens only once,” Griffin said. “But victims stay a long time in relationships where there is violence occurring for a number of reasons, and those most vulnerable to this cycle are economic, social and sexual minority groups.”

To determine how chronic and prevalent intimate partner violence is among this group of individuals and to determine whether sociodemographic characteristics have an effect, researchers surveyed 665 young people in New York City.

Data was drawn from Project 18, an ongoing cohort study funded by the National Institutes of Health that began in 2014. Participants recruited in two waves were between ages 18 and 24, self-reported being assigned male at birth, had sex with a male partner in the previous six months and were HIV-negative.

Participants were asked about their gender identity, race and ethnicity, sexual identity and income and education levels.

Nearly half of the participants (47.1 percent) reported being the victim of intimate partner violence in the past year. Psychological violence was the most common form of victimization reported, at 37.6 percent, followed by sexual violence (22.1 percent) and physical violence (19.5 percent). Psychological violence was the most common form of perpetration.

Bisexual, transgender and lower income participants were more likely to report victimization, while participants who were Asian and Pacific Islanders, bisexual, transgender and lower income were more likely to report perpetration of intimate partner violence.

Transgender participants were more likely to report severe psychological or minor and severe injury victimization than cisgender participants. Bisexual participants were more likely to report severe injury and severe sexual victimization than gay participants.

Participants who made less than $5,000 annually (34.6 percent of the sample) were more likely to report severe injury and minor and severe sexual victimization than participants who earned more than $5,000.

The findings suggest that intimate partner violence “is a prevalent and chronic health problem” for many young sexual and gender minorities assigned male at birth and reveal “sociodemographic disparities in [intimate partner violence] experiences in this historically-marginalized group …reflecting larger systems of oppression and privilege in our society,” the researchers noted in the study.

Griffin said the data should be used to develop intimate partner violence prevention and intervention programs and to develop and strengthen education and health policies.

“The takeaway from our work is that the range of people experiencing intimate partner violence is shockingly high, and that for sexual and gender minorities, the violence is often repeated,” Griffin said.

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JOURNAL

Journal of Interpersonal Violence

DOI

10.1177/08862605211021985 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Sociodemographic Differences in Intimate Partner Violence Prevalence, Chronicity, and Severity Among Young Sexual and Gender Minorities Assigned Male at Birth: The P18 Cohort Study

UTA project monitors Texas Gulf Coast climate hazards

Hummel leads effort to help coastal region develop plan for environmental hazards

Grant and Award Announcement

UNIVERSITY OF TEXAS AT ARLINGTON

 

IMAGE: MICHELLE HUMMEL view more 

CREDIT: UT ARLINGTON

A University of Texas at Arlington civil engineer is leading an interdisciplinary team to help Texas coastal communities and nonprofit organizations better monitor climate and industrial changes in their neighborhoods.

Michelle Hummel, assistant professor in the Department of Civil Engineering, is leading a $2.4 million National Science Foundation-funded project titled “SCC-IRG Track 1: Enabling Smart Cities in Coastal Regions of Environmental and Industrial Change: Building Adaptive Capacity Through Sociotechnical Networks on the Texas Gulf Coast.”

Co-principal investigators include Yonghe Liu, associate professor in the Department of Computer Science and Engineering; Karabi Bezboruah, associate professor of public affairs in the College of Architecture, Planning and Public Affairs (CAPPA); Oswald Jenewein, assistant professor of architecture in CAPPA; and Kathryn Masten, president and CEO of Maritimatix, a consulting firm that specializes in maritime informatics.

“This integrative research grant will apply a mixed-methods approach to assess how sociotechnical networks can be leveraged to build adaptive capacity in the Coastal Bend region of Texas, where communities are facing pressing environmental and industrial threats,” Hummel said. “Given the prevalence of environmental hazards like flooding and erosion and the proximity to energy, chemical and refining industries, it is imperative that the region has a plan.”

The project aims to strengthen multidisciplinary links among technical and social science professionals from academia, government agencies and community groups. The team will develop and deploy real-time environmental sensors to monitor air and water quality and to collect data on potential hazards and impacts.

“We want to provide our partner communities with usable data to strengthen sustainable planning and policies that benefit residents and the environment,” Hummel said.

The project will use the networking power of community-based organizations to assess how to best serve residents of the Coastal Bend. Community workshops and symposia will provide opportunities to evaluate and refine the solutions the research team develops.

“We aim to develop a framework for the collection, analysis and application of data that can be transferred to other communities and regions facing similar environmental and industrial challenges,” Hummel said.

Melanie Sattler, interim chair and professor in the Department of Civil Engineering, said this multidisciplinary project illustrates the far-reaching impact that university research can have on the world.

“This project will engage so many sectors to help coastal regions everywhere,” Sattler said. “Co-developing the research approach with the communities themselves is integral to the success of the project, as these are the people most impacted when something goes wrong. Bringing them into the data-gathering process to find solutions is great.”

Hummel said this project builds on a 2021 one-year planning grant that focused on one community in the Coastal Bend.

“As a result of our work and team-building efforts during our planning grant, we applied for and received this larger four-year, integrative research grant,” she said. “We will be working in the same area but expanding our reach to engage a diverse set of communities and nonprofits throughout the region.”

Study shows how urban environment influences physical activity in COPD patients

The findings show that patients living close to longer pedestrian streets walk more, while those living in more densely populated areas walk less

Peer-Reviewed Publication

BARCELONA INSTITUTE FOR GLOBAL HEALTH (ISGLOBAL)

The physical activity and exercise capacity of people with chronic obstructive pulmonary disease (COPD) appear to be related to population density, pedestrian street length, slope of terrain and exposure to nitrogen dioxide (NO2) in the vicinity of their homes, according to a new study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by the ”la Caixa” Foundation.

The study, recently published in Environmental Research, found that higher population density was associated with fewer steps taken by patients, more sedentary time and worse exercise capacity (with a stronger association being found in people with symptoms of depression). Longer pedestrian street lengths were associated with more steps and less sedentary time. Steeper slope was associated with greater exercise capacity. Finally, higher long-term exposure to NO2 (an indicator of traffic-related air pollution) was associated with more sedentary time and more difficulty with physical activity.

The researchers concluded that these neighbourhood environmental factors should be considered in clinical contacts with patients and when developing urban and transport planning policies aimed at promoting physical activity in patients with a chronic disease. Research on the urban environment has often ignored this population, which currently accounts for approximately 35% of urban dwellers in Europe.

COPD is characterised by progressive airflow limitation leading to shortness of breath and often limits the ability to perform daily activities. Patients are typically less active than healthy controls from the early stages of the disease onwards and this inactivity has a negative effect on COPD prognosis. Physical activity is therefore recommended for COPD patients and it is essential to know and understand which factors other than the disease itself may influence patients’ physical activity habits.

A Novel Research Question

The study aimed to estimate, in patients with mild to very severe COPD, the association between the urban environment and three variables: objective physical activity (daily step count and sedentary time), physical activity experience (perceived difficulty during activity) and functional exercise capacity (distance covered during six minutes of walking).

The study used data on 404 COPD patients from a multicentre study carried out in five seaside municipalities in Catalonia (Badalona, Barcelona, Mataró, Viladecans and Gavà). Eighty-five percent of the patients were men and the mean age was 69 years. On average, the patients walked 7,524 steps per day.

In order to estimate the urban environmental factors that each patient was exposed to, the researchers used geocoded residential addresses to determine census tract population density, length of pedestrian streets in the neighbourhood, slope of terrain, and long-term (i.e. annual) exposure to road traffic noise, NO2 and particulate matter (PM2.5).

Study Findings: Four Associations

“A first striking result is that greater population density was associated with worse physical activity and capacity outcomes in COPD patients,” commented Maria Koreny, postdoc external staff and lead author of the study. “It was thought that density could have a stimulating effect because it is associated with more shops and services, as well as better public transport, but when density is very high—as in Barcelona, where 46% of patients were recruited—it could have negative effects because of the increased dangers of traffic, fumes and noise.” Furthermore, the negative effect of high population density was found to be much stronger in patients with symptoms of depression, perhaps because of the embarrassment caused by symptoms such as shortness of breath and difficulty walking in public.

Secondly, regarding pedestrian street length, which was found to be linked to more steps and less sedentary time, Koreny commented: “There is debate as to whether pedestrian street length directly encourages more walking or whether this association could be explained by the fact that more pedestrian walkways reflect lower levels of air pollution, although our analysis does not support this latter hypothesis.”

Thirdly, the study found that steeper slope was associated with greater exercise capacity. According to Koreny, “COPD patients who live in a hilly neighbourhood may benefit from a continuous training effect.”

Finally, the study showed that higher NO2 levels were associated with more sedentary time and the experience of greater difficulty with physical activity. It is thought that higher levels of air pollution could increase shortness of breath in COPD patients, who might reduce exertion in order to avoid the feeling of breathlessness, which in turn would lead to muscular and cardiorespiratory deconditioning.

PM2.5 and noise exposure were not associated with physical activity or exercise capacity.

Using the Findings to Develop Strategies

“Our findings have implications for research, clinical management and urban health policy,” commented last author Judith Garcia-Aymerich, head of the Non-Communicable Diseases and Environment Programme at ISGlobal.

“These findings will allow for the development of strategies to effectively promote physical activity in COPD patients,” noted Garcia-Aymerich. One example would be to advise these patients to walk in hilly neighbourhoods (to improve their functional exercise capacity) and in less polluted areas or at lower-pollution times of day (to increase their physical activity and mitigate the negative effects of traffic-related air pollution).

She added: “It will be interesting to explore further the likely ‘utilitarian’ role of pedestrian streets, as well as the features of the microscale environment—for example, the availability and condition of benches—and how these features can be integrated into interventions to promote physical activity.”

The researchers also underscored the importance of addressing patients’ feelings of vulnerability associated with the chronic disease—such as breathlessness or embarrassment at being seen with limited mobility in COPD—as these may counteract the positive effects of environmental factors (e.g. liveable streets) observed in the general population. “These potential barriers to physical activity need to be addressed, especially with regard to patients with mental health issues,” explained Garcia-Aymerich.

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JOURNAL

Environmental Research

DOI

10.1016/j.envres.2022.113956 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Urban environment and physical activity and capacity in patients with chronic obstructive pulmonary disease

Prevalence of Online Sexual Offenses Against Children in the US

David Finkelhor, PhD¹; Heather Turner, PhD¹; Deirdre Colburn, MA¹

Author Affiliations Article Information

JAMA Netw Open. 2022;5(10):e2234471. doi:10.1001/jamanetworkopen.2022.34471

October 14, 2022

Key Points

Question  What are the lifetime prevalence and characteristics of online and technology-facilitated sexual abuse against children and youth?

Findings  In this national survey study of 2639 individuals, lifetime exposures were as follows: online child sexual abuse, 15.6%; image-based sexual abuse, 11.0%; self-produced child sexual abuse images, 7.2%; nonconsensual sexting, 7.2%; online grooming by adults, 5.4%; revenge pornography, 3.1%; sextortion, 3.5%; and online commercial sexual exploitation, 1.7%.

Meaning  Varied subtypes of online sexual abuse have different prevalence rates.

Abstract

Importance  Sexual abuse is increasingly facilitated by technology, but the prevalence and dynamics of such offenses have not been well delineated, making it difficult to design prevention strategies.

Objective  To examine the frequency and characteristics of online and technology-facilitated sexual abuse against children and youth.

Design, Setting, and Participants  In this nationally representative online survey study performed from November 19 to December 29, 2021, young adults aged 18 to 28 years were asked retrospectively about their childhood (<18 years) experiences of online and technology-facilitated abuse. The 2639 participants were sampled from an online panel.

Main Outcomes and Measures  Participants were asked questions about 11 different kinds of online and technology-facilitated sexual abuse with follow-up questions about their dynamics and offenders. Prevalence rates were calculated for several cross-cutting concepts (online child sexual abuse, image-based sexual abuse, self-produced child sexual abuse images, nonconsensual sexting, online grooming by adults, revenge pornography, sextortion, and online commercial sexual exploitation). Survey weights were applied to obtain population prevalence estimates.

Results  A total of 2639 individuals (48.5% male, 49.8% female, and 1.8% other gender; 23.7% Hispanic, 12.6% non-Hispanic Black, 53.9% non-Hispanic White, 4.8% other race, and 5.0% ≥2 races) were surveyed. Childhood (before 18 years of age) prevalence rates were as follows: online child sexual abuse, 15.6% (SE, 1.0%); image-based sexual abuse, 11.0% (SE, 0.9%); self-produced child sexual abuse images, 7.2% (SE, 0.7%); nonconsensual sexting, 7.2% (SE, 0.7%); online grooming by adults, 5.4% (SE, 0.5%); revenge pornography, 3.1% (SE, 0.5%); sextortion, 3.5% (SE, 0.6%); and online commercial sexual exploitation, 1.7% (SE, 0.3%). The prime age of vulnerability across all categories was 13 to 17 years. Perpetrators in most categories were predominantly dating partners, friends, and acquaintances, not online strangers.

Conclusions and Relevance  

The results of this national survey study suggest that a considerable portion of youth have experienced online child sexual abuse. Professionals planning prevention and intervention strategies for online sexual abuse should understand that dynamics include diverse episodes that are often extensions of dating abuse, sexual bullying, and sexual harassment, not only events perpetrated by adult internet predators.

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Prevalence of Online Sexual Offenses Against Children in the US | Adolescent Medicine | JAMA Network Open | JAMA Network